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utilization review nurse resume example with 20+ years of experience

JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 22 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.

Dedicated and well-qualified Rapid Response, Intensive Care Unit, Utilization Review RN offering proven skills in patient care, medication administration and treatment implementation. Detail-oriented, responsive and proficient in routine care and emergency response. Brings 22+ year record in field. Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities. Highly adaptable Utilization Review Nurse dedicated to providing exceptional skills in the hospital case environment. Smart and bilingual with developed interpersonal and time management skills. Seeking challenging role in setting devoted to quality patient care. Energetic individual offering 22 years' experience in reviewing compliance standards and auditing charts. Astute Utilization Review Nurse knowledgeable in medical data gathering, analysis and authorization obtainment.

Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments. Seeking the opportunity to join new organization in the role of Utilization Review Nurse. Hardworking and reliable, flexible, positive with strong ability in multitasking and prioritizing. Offering experience and eloquence. Highly organized, proactive and punctual with team-oriented mentality.

Skills
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Experience
01/2020 to Current Utilization Review Nurse Seattle Children's Hospital | Tacoma, WA,
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
  • Kept detailed documentation on all utilization reviews by using Epic.
  • Referred cases to secondary review for failure to meet inpatient criteria.
  • Determined medical necessity and cost-effectiveness of services through utilization review processes.
  • Contacted insurance carriers to obtain authorizations for services delivered to patients.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
  • Reviewed patient admissions to determine medical necessity as directed by Interqual/Indicia criteria.
03/2017 to Current Transition Nurse County Of Mchenry | Crystal Lake, IL,
  • Collaborated with transition team to evaluate care and discharge needs of current patient roster.
  • Followed up with recently discharged patients to check on care and upcoming visits and determine nursing needs.
  • Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
  • Referred patients to specialized health resources or community agencies to furnish additional assistance.
  • Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
  • Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
  • Worked with nursing staff and social workers to minimize healthcare burden by preventing unnecessary hospitalizations.
  • Modified patient treatment plans as indicated by patients' responses and conditions.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Fielded calls from patients, caregivers and family members to discuss needs and treatment options.
  • Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
  • Coordinated transition of care between settings such as hospitals, home and skilled nursing facilities.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
02/2016 to 01/2020 Rapid Response Nurse Hca | Keller, TX,
  • Conducted specified laboratory tests to help detect conditions and determine diagnosis.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Modified patient treatment plans as indicated by patients' responses and conditions.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Administered local, inhalation or intravenous anesthetics to patients undergoing procedures.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
  • Observed strict safety measures, including checking medication dosages before administration to patients.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
  • Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
  • Referred patients to specialized health resources or community agencies to furnish additional assistance.
  • Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
  • Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
  • Prepared medical equipment and tools to aid physician during examination and treatment of patients.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Administered oral, IV and intra-muscular medications and monitored patient reactions.
09/2000 to 02/2016 Intensive Care Unit Travel Registered Nurse American Mobile Healthcare | City, STATE,
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Achieved best possible outcomes for nursing sensitive indicators, core measures, HCAPS, patient satisfaction and associate satisfaction.
  • Functioned as charge nurse and assumed patient care in absence of nurses ending or arriving for shifts.
  • Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
  • Completed patient assessments, triaged and recorded patient histories, symptoms and observations.
  • Maintained records, prepared reports and served on special committees.
  • Worked with patients and families to provide in-hospital and after-hospital follow-up through teaching and referrals.
  • Assessed ICU patients each shift to ascertain vitals and key information.
  • Helped monitor, maintain and improve nursing-sensitive indicators, core measures and other identified outcome metrics.
  • Detected emerging problems by monitoring patients' behavior, vital signs and fluid intake and output.
  • Established and implemented nursing care plans for each patient using protocols of assessment, development, activation and evaluation.
  • Observed strict safety measures, including checking medication dosages before administration to patients.
  • Supported appropriate orientation, education, credentialing and continued professional development of associates.
  • Delivered optimum treatments to critical-care patients following prescribed rules, policies, protocol and procedures.
  • Evaluated patient vital signs and laboratory data to assess needs and provide emergency interventions.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Participated in development, implementation and evaluation of action plans for continuous performance improvement.
  • Developed and maintained professional relationship with members of health care team, patient and patient's family.
  • Checked on patients regularly to track progress with treatments, changes in symptoms and need for emergency interventions.
  • Kept track of patients' changing pain levels and proactively worked to minimize excess pain or discomfort.
  • Monitored patients' respiration activity, blood pressure and blood glucose levels in response to medical administration.
  • Identified abnormal and critical respiratory patterns through direct pulmonary assessments.
  • Supervised cardiac monitors, mechanical ventilators and alarms and oxygen delivery devices.
Education and Training
Expected in 05/2009 Master of Science | Nursing Grand Canyon University, Phoenix, AZ GPA:
Expected in 06/1998 Diploma of Health Science | Nursing St. Clair College of Applied Arts And Technology, Ontario, Canada, GPA:

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Resume Overview

School Attended

  • Grand Canyon University
  • St. Clair College of Applied Arts And Technology

Job Titles Held:

  • Utilization Review Nurse
  • Transition Nurse
  • Rapid Response Nurse
  • Intensive Care Unit Travel Registered Nurse

Degrees

  • Master of Science
  • Diploma of Health Science

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